Using Modifier 25 in Otolaryngology: Rewards and Ramifications

Using Modifier 25 in Otolaryngology: Rewards and Ramifications 

Total Runtime: 1 hour and 36 minutes

Cost: $249

Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward.  But is it correct?

Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from otolaryngologists – the ramification.  A common misconception is that the E/M code and procedure code are always billed together.  That’s just not true.  There are times when it is not appropriate to also report the E/M code but bill only the procedure.

We will examine the CPT guidelines about using modifier 25 as well as what Medicare says.  Several scenarios frequently encountered in otolaryngology practices will be reviewed.  You will have a better understanding of how to correctly use modifier 25 when performed with the common ENT minor procedures including:

• Nasal endoscopy
• Flexible laryngoscopy
• Endoscopic sinus debridement
• Excision of skin lesion, and
• Cerumen removal

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If you have any issues with completing your registration please email us at education@karenzupko.com or call 312 642-8310